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Postscript
What will the 21st century hold
for me? And for other
psychiatrists, who are
increasingly being forced, by
social conditions and trends, to treat multicultural populations in America and
most other countries around the world? I cannot predict the future, of course. But
I am certain that, in my own case, there are bound to be many surprises, as there
have been throughout my life-beginning with my departure from China to the
Philippines, and continuing over the past 30 years of my professional life, when I
began my "multicultural odyssey" as a psychiatrist in Sarawak.
Last year, by the way, I actually revisited Sarawak-after a hiatus of 29
years. Why? I did not go to do follow-up research or chase some dream of another
research project. Rather, I took a sentimental journey, of sorts, to see the field
workers and their families involved in the original research project. During my
visit, the most touching thing that caught my attention was in the restaurants they
took me to: On the checks, a caption was written that said a certain percentage of
the taxes go to mental health programs! How happy I was to see this positive
residue of our long-ago effort in Sarawak!
As I look back on my career, from the 1960s to the 1990s, I see that I have
been inexorably drawn to the many instructive, dramatic, and bizarre occurrences
that came along, as I studied, learned, and grew with the psychiatric movement in
America. A thirty-year span is, indeed, a long time for someone-even a trained
Psychiatrist-to recapture his own perceptions, and to make them meaningful to
lay readers, as well as to professional mental health workers. These recollections,
no doubt, have at times appeared clouded. Nonetheless, in this book I have
attempted to gather and organize materials chronologically from the different
healthcare institutions and projects in which I have participated, as a student,
researcher, and practitioner, and to present my views about them and the patients
we have studied and treated.
Throughout much of the 20th century, I have flowed like a river, so to speak,
from sea to sea. From one culture to another. From one kind of thinking to
another. There has been so much to assimilate and make sense of. Along the
course of my travels, I have wondered, among many other things, How does each
culture attempt to cope with and solve each mental health problem? Is there the
possibility of establishing uniform ways of coping with mental health problems
for all cultures? I have yet to arrive at definitive answers, but I do feel an
enormous sense of progress being made by my profession, at least in the area of
psychopharmacology. Could it be that "popping a pill" or "getting a shot" will,
indeed, be the solution to our most pressing mental health problems in the near
future? They may be, especially if medical researchers continue the present trend
of attributing more and more behaviors-and even thinking and feeling-to
genetic and biochemical factors.
In my travels, however, I have seen that a simple, caring, human approach can
also benefit the mentally ill. This fact was made very clear to me on a recent trip
to Malta, where I took an impromptu tour of the mental health facility of the
General Hospital in Gozo, an island easily approached by ferry from the main
island. The facility, separated from the hospital physically, is situated in the hilly
section of town, which is quite idyllic for contemplative repose.
The building is one story high. Spread spaciously in a semicircular fashion are
the different units of services, including outpatient care, short-term stay,
long-term stay, and a geriatric component. The staff is composed of two fulltime
psychiatrists and an indeterminate number of social workers and psychologists. In
addition, two fulltime priests alternate on a 24-hour basis, offering multiple
services, such as individual and family counseling, patient advocacy, and home
visits to assess crisis situations.
Though my visit was very brief, I came away with a good feeling, and was
impressed by the care given to the mentally disabled by the professionals in the
various disciplines and the nonclinical staff. To me, it looked like one big family
sharing all kinds of vicissitudes of life and coping with them. My experience on
this tiny, Mediterranean island reinforced my conviction that one does not need to
have the powerful technologies of modern psychiatric institutions to reach the
mentally ill.
From the very beginning of my psychiatric training, to my exposure to the
diversity of patients I have seen and treated, I have been very fortunate. I've also
been fortunate to have worked with so many fascinating, intelligent, and caring
colleagues and collaborators from myriad ethnic backgrounds. This good fortune
continues right to the present time, as in my association, for example, with the
Guatemalan social worker at Sunset Terrace who gives me insight into her
country's historical upheaval and struggles for human rights.
Although I feel, at times, that I have "swallowed the world" from my diverse
transcultural experiences, I realize that my personal odyssey represents but a
narrow path, a small span, a minuscule portion of the whole spectrum of the
mental health movement. My "crossings" over and through this movement have
been atypical-perhaps even irreverent-compared to the career paths of
conventional psychiatrists, who typically work in placid, private practice or
institutional settings, and treat patients similar in terms of socio-cultural and
demographic characteristics.
While I may have deliberately moved away from the traditional road, I also
may have been swayed by the myriad opportunities that came along these past 30
years. I rationalize that there will eventually be changes of policies and privileges
affecting psychiatric practice, as we move on to the 21st century. So I have taken
chances. I have taken to the streets and jungles.
And in the course of these adventures, I have begun to see the multitudinal
tiers of variable mental health system components-ethnic, sociocultural,
religious, educational, psychological, and political-that need to be taken into
consideration in the care of the mentally ill in the community. This book may not
have clearly spelled out the inner workings of each variant, but we are being
confronted by them every day. I strongly urge, therefore, that mental health
researchers conduct more studies in these areas in the very near future.
In closing my book, I hope that if you've taken only one message with you
that I tried to convey, no matter how implicitly, it is this: There is still hope for
people in every ethnic group to come to live together with a child's innocence and
a sage's heart.
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